TY - JOUR
T1 - Use of sedatives, opioids, and neuromuscular blocking agents in patients with acute lung injury and acute respiratory distress syndrome
AU - Arroliga, Alejandro C.
AU - Thompson, B. Taylor
AU - Ancukiewicz, Marek
AU - Gonzales, Jeffrey P.
AU - Guntupalli, Kalpalatha K.
AU - Park, Pauline K.
AU - Wiedemann, Herbert P.
AU - Anzueto, Antonio
N1 - Funding Information:
Supported, in part, by contracts No-1-HR 46054 through 46064 with the National Institutes of Health, National Heart, Lung, and Blood Institute ARDS Clinical Network.
Funding Information:
Dr. Anzueto has consulted for Bayer, Pfizer, and BI. He has also received honoraria from GlaxoSmithKline, BI, and Pfizer and received grant support from GlaxoSmithKline and BI (paid to the university). The remaining authors have not disclosed any potential conflicts of interest.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2008/4
Y1 - 2008/4
N2 - OBJECTIVE: The use of sedatives, opioids, and neuromuscular blocking agents (NMBAs) may delay weaning and prolong intensive care unit length of stay. We hypothesized that in patients on higher positive end-expiratory pressure (PEEP), sedatives, opioids, and NMBAs are used in a higher proportion of patients and in higher doses and that the use of these medications is associated with prolongation of weaning and mortality. DESIGN: Retrospective analysis. SETTING: The ALVEOLI trial. PATIENTS: Five hundred forty-nine patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) who were enrolled in the ALVEOLI trial. INTERVENTIONS: We analyzed prospectively collected data regarding the impact of sedatives, opioids, and NMBAs in ALI/ARDS patients on duration of mechanical ventilation, time to weaning landmarks, and mortality. MEASUREMENTS AND MAIN RESULTS: Sedatives and opioids were used in >80% of the patients in similar proportion in the two groups. The use of sedatives and opioids, but not the use of NMBAs, was associated with longer time on mechanical ventilation and an increased time to achieve a 2-hr spontaneous breathing trial (p < .0001). Sedatives were also associated with increased time to achieve unassisted breathing. NMBAs were used for a short period of time, in a higher proportion of patients in the lower PEEP group, and for a longer time (0.23 days). CONCLUSIONS: Sedatives and opioids use was similar in the higher and lower PEEP groups. The use of sedatives and opioids, but not NMBAs, was associated with a longer time to achieve important weaning landmarks.
AB - OBJECTIVE: The use of sedatives, opioids, and neuromuscular blocking agents (NMBAs) may delay weaning and prolong intensive care unit length of stay. We hypothesized that in patients on higher positive end-expiratory pressure (PEEP), sedatives, opioids, and NMBAs are used in a higher proportion of patients and in higher doses and that the use of these medications is associated with prolongation of weaning and mortality. DESIGN: Retrospective analysis. SETTING: The ALVEOLI trial. PATIENTS: Five hundred forty-nine patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) who were enrolled in the ALVEOLI trial. INTERVENTIONS: We analyzed prospectively collected data regarding the impact of sedatives, opioids, and NMBAs in ALI/ARDS patients on duration of mechanical ventilation, time to weaning landmarks, and mortality. MEASUREMENTS AND MAIN RESULTS: Sedatives and opioids were used in >80% of the patients in similar proportion in the two groups. The use of sedatives and opioids, but not the use of NMBAs, was associated with longer time on mechanical ventilation and an increased time to achieve a 2-hr spontaneous breathing trial (p < .0001). Sedatives were also associated with increased time to achieve unassisted breathing. NMBAs were used for a short period of time, in a higher proportion of patients in the lower PEEP group, and for a longer time (0.23 days). CONCLUSIONS: Sedatives and opioids use was similar in the higher and lower PEEP groups. The use of sedatives and opioids, but not NMBAs, was associated with a longer time to achieve important weaning landmarks.
KW - Acute respiratory distress syndrome
KW - Benzodiazepines
KW - Neuromuscular blockers
KW - Opioids
KW - Propofol
KW - Sedatives
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U2 - 10.1097/CCM.0B013E3181653895
DO - 10.1097/CCM.0B013E3181653895
M3 - Article
C2 - 18401254
AN - SCOPUS:41649110117
VL - 36
SP - 1083
EP - 1088
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 4
ER -